Effect of community-based newborn-care intervention package implemented through two service-delivery strategies in Sylhet district, Bangladesh: a cluster-randomised controlled trial
Effect of community-based newborn-care intervention package implemented through two service-delivery strategies in Sylhet district, Bangladesh: a cluster-randomised controlled trial
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DOI：
10.1016/s0140-6736(08)60835-1
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发表时间：
2008-06-07
期刊：
影响因子：
168.9
通讯作者：
Black, Robert E.
中科院分区：
文献类型：
--
作者：
Baqui, Abdullah H.;El-Arifeen, Shams;Black, Robert E.
背景在孟加拉国5岁以下儿童死亡中，新生儿死亡率占很高比例。因此，促进新生儿和母亲健康项目(Projahnmo)通过政府和非政府组织的基础设施实施了一项以社区为基础的干预方案，以降低新生儿死亡率。方法在西尔赫特区，将24个组(每个组约20000人)随机分配到两个干预组中的一个或对照组。由于研究设计的原因，掩蔽是不可行的。所有已婚育龄妇女(15-49岁)都有资格参加。在家庭护理部门，女性社区卫生工作者(每4000人中有一人)识别孕妇，进行两次产前家访以促进分娩和新生儿护理准备，在出生后第一天、第三天和第七天进行产后家访以评估新生儿，并转介或治疗患病新生儿。在社区护理部门，仅通过由女性和男性社区动员人员举办的小组会议来促进合格提供者的分娩和新生儿护理准备和照料。主要结果是新生儿死亡率降低。分析采用意向治疗。这项研究在ClinicalTrials.gov注册，编号00198705。发现每只手臂的簇数为8个。家庭护理、社区护理和对照护理的参与者人数分别为36059人、40159人和37598人，活产分别为14769人、16325人和15350人。干预30个月后6个月，家庭护理组、社区护理组和对照组新生儿死亡率分别为29.2/1000、45.2/1000和43.5/1000。家庭护理组的新生儿死亡率降低了34%(调整后的相对风险为0。66；95%可信区间0.47~0.93)。社区护理组的死亡率没有下降(0。95；0。69-1.31)解释一种家庭护理战略，旨在促进预防和治疗性新生儿护理的综合方案，在卫生系统薄弱、卫生保健使用率低和新生儿死亡率高的社区有效地降低新生儿死亡率。
Background Neonatal mortality accounts for a high proportion of deaths in children under the age of 5 years in Bangladesh. Therefore the project for advancing the health of newborns and mothers (Projahnmo) implemented a community-based intervention package through government and non-government organisation infrastructures to reduce neonatal mortality.Methods In Sylhet district, 24 clusters (with a population of about 20000 each) were randomly assigned in equal numbers to one of two intervention arms or to the comparison arm. Because of the study design, masking was not feasible. All married women of reproductive age (15-49 years) were eligible to participate. In the home-care arm, female community health workers (one per 4000 population) identified pregnant women, made two antenatal home visits to promote birth and newborn-care preparedness, made postnatal home visits to assess newborns on the first, third, and seventh days of birth, and referred or treated sick neonates. In the community-care arm, birth and newborn-care preparedness and careseeking from qualified providers were promoted solely through group sessions held by female and male community mobilisers. The primary outcome was reduction in neonatal mortality. Analysis was by intention to treat. The study is registered with ClinicalTrials.gov, number 00198705.Findings The number of clusters per arm was eight. The number of participants was 36059, 40159, and 37598 in the home-care, community-care, and comparison arms, respectively, with 14769,16325, and 15350 livebirths, respectively. In the last 6 months of the 30-month intervention, neonatal mortality rates were 29.2 per 1000, 45.2 per 1000, and 43.5 per 1000 in the home-care, community-care, and comparison arms, respectively. Neonatal mortality was reduced in the home-care arm by 34% (adjusted relative risk 0 . 66; 95% CI 0.47-0.93) during the last 6 months versus that in the comparison arm. No mortality reduction was noted in the community-care arm (0 . 95; 0 . 69-1.31).Interpretation A home-care strategy to promote an integrated package of preventive and curative newborn care is effective in reducing neonatal mortality in communities with a weak health system, low health-care use, and high neonatal mortality.Funding United States Agency for International Development and saving newborn lives programme by Save the Children (US) with a grant from Bill and Melinda Gates Foundation.